Chemical Background
The patent application WO 90/14334 describes mono-substituted N-phenylalkyl alpha-amino carboxamide derivatives of the following general formula
whereinR is a (C1-C8)alkyl, (C3-C8)cycloalkyl, furyl, thienyl, pyridyl or a phenyl ring optionally substituted by 1 to 4 substituents independently selected from halo, (C1-C6)alkyl, (C1-C6)alkoxy and trifluoromethyl; A is a —(CH2)m—, —(CH2)p—X—(CH2)q— group wherein m is an integer of 1 to 4, one of p and q is zero and the other is zero or an integer of 1 to 4, X is —O—, —S— or —NR4— in which R4 is hydrogen or (C1-C4)alkyl; n is 0 or 1; each of R1 and R2 independently is hydrogen or (C1-C4)alkyl; R3 is hydrogen, (C1-C4)alkyl optionally substituted by hydroxy or phenyl optionally substituted as above; R3′ is hydrogen or R3 and R3′ taken together form a (C3-C6)cycloalkyl ring; each of R5 and R6 independently is hydrogen or (C1-C6) alkyl; and their use as anti-epileptic, anti-Parkinson, neuroprotective, anti-depressant, anti-spastic and/or hypnotic agents.
The compound 2-[2-[4-(3-chlorobenzyloxy)-phenyl]-ethylamino]-acetamide and its hydrochloride salt and the preparation thereof are specifically described in the above patent application. (See also P. Pevarello and al. in J. Med. Chem. 1998, 41, 579-590.)
The compounds (S)-2-[2-[4-benzyloxy-phenyl]-ethylamino]-acetamide, (S)-2-[2-[4-(2-cholorobenzyloxy)-phenyl]-ethylamino]-acetamide, 2-[2-(4-benzyl-phenyl)-ethylamino]-acetamide and 2-[2-(4-benzylamino-phenyl)-ethylamino]-acetamide are mentioned, but not characterized, in WO 90/14334.
The patent application WO 04/089353 describes a method and a combination therapy for the treatment of Parkinson'disease by using safinamide ((S)-(+)-2-[4-(3-fluoro-benzyloxy)-benzylamino]-propanamide), a safinamide derivative or a MAO-B inhibitor together with anti-Parkinsonian agents. The compound 2-[2-[4-(3-chloro-benzyloxy)-phenyl]-ethylamino]-acetamide is exemplified in the invention.
The above compound is also prepared and described as anticonvulsant (Pevarello P., Bonsignori A., Dostert P., Heidempergher F., Pinciroli V., Colombo M., McArthur R. A., Salvati P., Post C., Fariello R. G., Varasi M. J. Med. Chem. (1998) 41: 579-590).
The patent application WO 99/35125 describes alpha-aminoamide derivatives of the general formula
whereinR is a furyl, thienyl, pyridyl or a phenyl ring; A is a —(CH2)m—, —(CH2)n—X— or —(CH2)v—O— group wherein m is an integer of 1 to 4, n is zero or an integer of 1 to 4, X is —S— or —NH— and v is zero or an integer of 1 to 5; s is 1 or 2; R1 is hydrogen or (C1-C4)alkyl; one of R2 and R3 is hydrogen and the other is hydrogen or (C1-C4)alkyl optionally substituted by hydroxy or phenyl; or R2 and R3 taken together form a (C3-C6)cycloalkyl ring; or R2 and R3 are both methyl; R4 is hydrogen or C1-C4 alkyl; and their use as analgesic agents.
The compound 2-[2-[4-(3-chloro-benzyloxy)-phenyl]ethylamino]-propanamide in the above patent application is mentioned.
The patent application WO 03/091219 describes 5-(benzyloxy)-2-(iodophenyl)-ethylamino derivatives (see formula XII), which are employed as intermediates in the preparation of isoquinolines as monoamine oxidase B inhibitors useful against Alzheimer's disease and senile dementia:
wherein, inter alia, m is 1, 2, or 3; R2 is selected from halogen, halogen —(C1-C6)alkyl, cyano, (C1-C6)alkoxy or halogen —(C1-C6)alkoxy; R11 is hydrogen; n is 0, 1 or 2; R4 and R5 are independently selected from hydrogen, (C1-C6)alkyl, —(CH2)p—OR8, —(CH2)p—SR8 or benzyl, wherein p is 1 or 2 and R8 is hydrogen or (C1-C6)alkyl.
WO 99/26614 discloses substituted 2-(benzylamino)acetamides and their use for treating disorders responsive to the blockade of sodium ion channels, including preventing or ameliorating neuropathic pain.
WO 03/037865 relates to compounds useful in the treatment of cancer of general formula
wherein the symbols R1, R2, R3X, U and Y may assume a wide series of meanings. Although some combinations of said broad generic meanings might include phenethylamino derivatives, none of the compounds described in this application is actually disclosed in WO 03/037865. U.S. Pat. No. 5,366,982 (WO 92/01675) relates to compounds having selective leucotriene B4 (LTB4) antagonist properties, encompassed by the general formula
wherein the symbols R, R′, R2, R3, R4, X, Y, Z W, n, m and Q may assume a wide series of meanings. Notwithstanding some combinations of said generic meanings might encompass also phenethylamino derivatives, none of the compounds described in this application is actually disclosed in U.S. Pat. No. 5,366,982.
WO 98/35957 discloses acetamide derivatives active as antagonists of neuropeptide Y receptor, particularly useful in the treatment of obesity, of general formula
where the symbols R1, R2, R3, R4 and R5 may assume a wide series of meanings. None of the compounds described in this application is actually disclosed in WO 98/35957.
EP 1588704A discloses alfa-aminoamide derivatives, including (S)—(+)-2-[4-(2-fluoro-benzyloxy)-benzylamino]-propanamide, i.e. ralfinamide, for use in the treatment of Restless Leg Syndrome.
WO 2005/018627 discloses alfa-aminoamide derivatives, including ralfinamide, for use as therapeutic anti-inflammatory agents
Biological Background
Calcium channels are membrane-spanning, multi-subunit proteins that allow controlled entry of calcium ions into cells from the extracellular fluid. Commonly, calcium channels are voltage dependent and are referred to as voltage-gated calcium channels (VGCC). VGCCs are found throughout the mammalian nervous system, where they regulate the intracellular calcium ions levels that are important for cell viability and function. Intracellular calcium ion concentrations are implicated in a number of vital processes in animals, such as neurotransmitter release, muscle contraction, pacemaker activity and secretion of hormones. All “excitable” cells in animals, such as neurons of the central nervous system (CNS), peripheral nerve cells, and muscle cells, including those of skeletal muscles, cardiac muscles and venous and arterial smooth muscles, have voltage dependent calcium channels.
Calcium channels are a large family with many genetically, physiologically, and pharmacologically distinct subtypes. Based on the biophysical properties of calcium currents recorded from individual neurons, two super-families have been described: High Voltage Activated (HVA) and Low Voltage Activated (LVA) calcium channels. Calcium currents referred as L-Type, P-Type, Q-Type, N-Type, R-Type are HVA and as T-Type are LVA. In particular, the term “L-type” was originally applied to channels with a large single channel conductance and long open time, and “T-type” was applied to channels with a tiny single channel conductance and a transient open time. Further exploration of functional calcium channel diversity identified the “N-type” channel expressed in neurons and the “P-type” channel, which is the dominant type expressed in cerebellar Purkinje neurons and is pharmacologically resistant to known blockers of L-type and N-type calcium channels. From the molecular identity, ten distinct calcium subtypes have been identified, cloned and expressed and grouped in three families: Cav1 family (Cav 1.1, 1.2, 1.3, 1.4) is functionally related to the L-type Ca current; Cav2 family (Cav 2.1, 2.2, 2.3) is functionally related to the P/Q, N, R-type currents and Cav3 (Cav 3.1, 3.2, 3.3) family is functionally related to the T-type current.
It is believed that calcium channels are relevant in certain disease states. A number of compounds useful in treating various cardiovascular diseases in mammals, including humans, are thought to exert their beneficial effects by modulating functions of voltage dependant calcium channels present in cardiac and/or vascular smooth muscle. Compounds with activity against calcium channels have also been implicated for the treatment of pain. In particular N-type calcium channels (Cav2.2), responsible for the regulation of neurotransmitter release, are thought to play a significant role in nociceptive transmission, both due to their tissue distribution as well as from the results of several pharmacological studies. N-type calcium channels were found up-regulated in the ipsilateral dorsal horn in neuropathic pain models of injury (Cizkova D., Marsala J., Lukacova N., Marsala M., Jergova S., Orendacova J., Yaksh T. L. Exp. Brain Res. (2002) 147: 456-463). Specific N-type calcium channel blockers were shown to be effective in reducing pain responses in neuropathic pain models (Mattews E. A., Dickenson A. H. Pain (2001) 92: 235-246), in the phase II of the formalin test (Diaz A., Dickenson A. H. Pain (1997) 69: 93-100) and the hyperalgesia initiated by knee joint inflammation (Nebe J., Vanegas H., Schaible H. G. Exp. Brain Res. (1998) 120: 61-69). Mutant mice, lacking the N-type calcium channels, were found to have a decreased response to persistent pain as seen by a decrease in pain response during phase II of the formalin test (Kim C., Jun K., Lee T., Kim S. S., Mcenery M. W., Chin H., Kim H. L, Park J. M., Kim D. K., Jung S. J., Kim J., Shin H. S. Mol. Cell. Neurosci. (2001) 18: 235-245; Hatakeyama S., Wakamori M, Ino M., Miyamoto N., Takahashi E., Yoshinaga T., Sawada K., Imoto K., Tanaka I., Yoshizawa T., Nishizawa Y., Mori Y., Nidome T., Shoji S, Neuroreport (2001) 12: 2423-2427) as well as to neuropathic pain, assessed by a decrease in mechanical allodynia and thermal hyperalgesia in the spinal nerve ligation model. Interestingly, these mice also showed lower levels of anxiety when compared to wild type (Saegusa H., Kurihara T., Zong S., Kazuno A., Matsuda Y. Nonaka T., Han W., Toriyama H., Tanabe T., EMBO J. (2001) 20: 2349-2356). The involvement of N-type calcium channels in pain has been further validated in the clinic by ziconotide, a peptide derived from the venom of the marine snail, Conus Magnus. A limitation in the therapeutic use of this peptide is that it has to be administered intrathecally in humans (Bowersox S. S, and Luther R. Toxicon, (1998) 36: 1651-1658).
Sodium channels play an important role in the neuronal network by transmitting electrical impulses rapidly throughout cells and cell networks, thereby coordinating higher processes ranging from locomotion to cognition. These channels are large transmembrane proteins, which are able to switch between different states to enable selective permeability for sodium ions. For this process an action potential is needed to depolarize the membrane, and hence these channels are voltage-gated. In the past few years a much better understanding of sodium channels and drugs interacting with them has been developed.
Voltage-gated sodium channels were originally classified based on their sensitivity to tetrodotoxin, from low nanomolar (Tetrodotoxin sensitive, TTXs) to high micromolar (Tetrodotoxin resistant, TTXr). So far, 10 different sodium channel α subunits have been identified and classified as Nav1.1 to Nav1.9. Nav1.1 to Nav1.4, Nav1.6 and Nav1.7 are TTXs, whereas Nav1.5, Nav1.8 and Nav.1.9 are TTXr, with different degrees of sensitivity. Nav1.1 to Nav1.3 and Nav1.6, are primarily expressed in the CNS, whereas Nav1.4 and Nav1.5 are mainly expressed in muscle (skeletal and heart respectively) and Nav1.8 and Nav1.9 are predominantly expressed in small DRGs.
It has become clear that a number of drugs having an unknown mechanism of action actually act by modulating sodium channel conductance, including local anaesthetics, class I antiarrhythmics and anticonvulsants. Neuronal sodium channel blockers have found application with their use in the treatment of epilepsy (phenyloin and carbamazepine), bipolar disorder (lamotrigine), preventing neurodegeneration, and in reducing neuropathic pain. Various anti-epileptic drugs that stabilize neuronal excitability are effective in neuropathic pain (gabapentin, carbamazepine).
In addition, an increase in sodium channel expression or activity has also been observed in several models of inflammatory pain, suggesting a role of sodium channels in inflammatory pain.
All together these findings indicate that compounds with sodium and/or calcium channel blockade have a high therapeutic potential in preventing, alleviating and curing a wide range of pathologies, including neurological, psychiatric, cardiovascular, urogenital and gastrointestinal diseases, where the above mechanisms have been described as playing a pathological role.
There are many papers and patents which describe sodium channel and/or calcium channel modulators or antagonists for the treatment or modulation of a plethora of disorders, such as their use as local anaesthetics, antiarrhythmics, antiemetics, antimanic anti-depressants, agents for the treatment of unipolar depression, cardiovascular diseases, urinary incontinence, diarrhoea, inflammation, epilepsy, neurodegenerative conditions, nerve cell death, neuropathic pain, migraine, acute hyperalgesia and inflammation, renal disease, allergy, asthma, bronchospasm, dysmenorrhea, esophageal spasm, glaucoma, urinary tract disorders, gastrointestinal motility disorders, premature labour, obesity.
A non-exhaustive list of such papers and patents/patent applications describing sodium and/or calcium channels blockers and uses thereof includes the references shown below.
C. Alzheimer describes in Adv. Exp. Med. Biol. 2002, 513, 161-181, sodium and calcium channels as targets of neuroprotective substances.
Vanegas e Schaible (Pain 2000, 85, 9-18) discuss effects of antagonists of calcium channels upon spinal mechanisms of pain, hyperalgesia and allodynia.
U.S. Pat. No. 5,051,403 relates to a method of reducing neuronal damage associated with an ischemic condition, such as stroke, by administration of binding/inhibitory omega-conotoxin peptide wherein the peptide is characterized by specific inhibition of voltage-gated calcium channel currents selectively in neuronal tissues.
U.S. Pat. No. 5,587,454 relates to compositions and methods of producing analgesia particularly in the treatment of pain and neuropathic pain.
U.S. Pat. No. 5,863,952 relates to calcium channel antagonists for the treatment of ischaemic stroke.
U.S. Pat. No. 6,011,035 relates to calcium channel blockers, useful in the treatment of conditions such as stroke and pain.
U.S. Pat. No. 6,117,841 relates to calcium channel blockers and their use in the treatment of stroke, cerebral ischemia, pain, head trauma or epilepsy.
U.S. Pat. No. 6,362,174 relates to N-type calcium channel blockers in the treatment of stroke, cerebral ischemia, pain, epilepsy, and head trauma.
U.S. Pat. No. 6,380,198 concerns the use of the calcium channel blocker flunarizine for the topical treatment of glaucoma.
U.S. Pat. No. 6,420,383 and U.S. Pat. No. 6,472,530 relate to novel calcium channel blockers, useful for treating and preventing a number of disorders such as hypersensitivity, allergy, asthma, bronchospasm, dysmenorrhea, esophageal spasm, glaucoma, premature labor, urinary tract disorders, gastrointestinal motility disorders and cardiovascular disorders.
U.S. Pat. No. 6,458,781 relates to compounds that act to block calcium channels and their use to treat stroke, cerebral ischemia, pain, head trauma or epilepsy.
U.S. Pat. No. 6,521,647 relates to the use of calcium channel blockers in the treatment of renal disease in animals, especially chronic renal failure.
WO 97/10210 relates to tricyclic heterocyclic derivatives, and their use in therapy, in particular as calcium channel antagonists, e.g. for the treatment of ischaemia, in particular ischaemic stroke.
WO 03/018561 relates to quinoline compounds as N-type calcium channel antagonists and methods of using such compounds for the treatment or prevention of pain or nociception.
WO 03/057219 relates to sodium channel blockers useful as agents for treating or modulating a central nervous system disorder, such as neuropathic pain, inflammatory pain, inflammation-related pain or epilepsy.
WO99/14199 discloses substituted 1,2,3,4,5,6-hexahydro-2,6-methano-3-benzazocines-10-oles as potent sodium channel blockers useful for the treatment of several diseases, such as stroke, neurodegenerative disorders, Alzheimer's Disease, Parkinson's Disease and cardiovascular disorders.
WO01/74779 discloses new aminopyridine sodium channel blockers and their use as anticonvulsants, local anesthetics, as antiarrythmics, for the treatment or prevention of neurodegenerative conditions, such as amyotrophic lateral sclerosis (ALS), for the treatment or prevention of both, acute or chronic pain, and for the treatment or prevention of diabetic neuropathy.
WO04/087125 discloses amino acid derivatives as inhibitors of mammalian sodium channels, useful in the treatment of chronic and acute pain, tinnitus, bowel disorders, bladder dysfunction and demyelinating diseases.
Monoamine oxidase (MAO) is an enzyme present in the outer mitochondrial membrane of neuronal and non-neuronal cells. Two isoforms of MAO exist: MAO-A and MAO-B. MAO enzymes are responsible for the oxidative deamination of endogenous and xenobiotic amines, and have a different substrate preference, inhibitor specificity, and tissue distribution. For MAO-A serotonin, noradrenaline and adrenaline are preferential substrates, and clorgyline is a selective MAO-A inhibitor; whereas MAO-B prefers β-phenylethylamine as a substrate, and is almost selectively inhibited by selegiline. Dopamine, tyramine and tryptamine are oxidized by both MAO-A and MAO-B, in particular in human brain dopamine is deaminated by 80% by MAO-B.
MAO inhibition allows endogenous and exogenous substrates to accumulate and may thereby, when almost fully inhibited (>90%), alter the dynamics of regular monoamine transmitters. MAO regulate the concentrations in the brain of the most important neurotransmitters such as noradrenaline, serotonin and dopamine which are related to emotion, anxiety and movement. Thus, it is thought that MAO be closely linked to various psychiatric and neurological disorders such as depression, anxiety and Parkinson's disease (PD).
MAO-A inhibitors are mainly used in psychiatry for the treatment of major, refractory and atypical depression as a consequence of their ability to increase the reduced serotonin and noradrenalin brain levels. More recently, MAO-A inhibitors have been used to treat patients with anxiety disorders such as social phobia, panic disorders, post-traumatic stress disorders and obsessive compulsive disorders.
MAO-B inhibitors are mainly used in neurology for the treatment of PD.
There is also recent evidence and interest in the role of MAO-B in other pathological conditions such as Alzheimer disease (AD). So far no evidence have been reported on MAO-B involvement in the metabolism of co-transmitters, such as colecystokinin, substance P, somatostatin and neurotensin, which are involved in the modulation of pain sensation. For this reason there is no scientific rationale for the use of MAO-B inhibitors in pain syndromes. Adverse drug reactions during clinical practice with MAO inhibitors have been reported. First generation of non-selective and irreversible MAO inhibitors, such as tranylcypromide and phenelzine, have serious side effects, including hepatotoxicity, orthostatic hypotension and most importantly hypertensive crisis that occurs following the ingestion of foods containing tyramine (Cooper A J.—Tyramine and irreversible monoamine oxidase inhibitors in clinical practice.—Br J Psych Suppl 1989:38-45).
When these non-selective and irreversible MAO inhibitors are used, a strict tyramine-reduced diet must be observed. The pressor sensitivity towards tyramine is normalized 4 weeks after cessation of tranylcypromine therapy and more than 11 weeks after cessation of phenelzine therapy.
Selegiline, a almost selective and irreversible MAO-B inhibitor, especially when used in combination with levodopa, can cause anorexia/nausea, dry mouth, dyskinesia and orthostatic hypotension in patients with PD, the latter being most problematic (Volz H. P. and Gleiter C. H.—Monoamine oxidase inhibitors. A perspective on their use in the elderly.—Drugs Aging 13 (1998), pp. 341-355).
In monotherapy, anorexia/nausea, musculoskeletal injuries, and cardiac arrhythmias occurred more often in patients receiving selegiline compared with those receiving placebo. Apart from these adverse effects, increased rates of elevated serum AST and ALT levels were noted.
The most frequently reported adverse effect of moclobemide, a selective and reversible MAO-A inhibitor, are sleep disturbances, increased anxiety, restlessness, and headache.
The combination of selective serotonin reuptake inhibitors (SSRIs) and moclobemide has good efficacy in cases of refractory depression, but has created controversy as to whether toxic side effects, such as serotonergic syndrome, result from this combination (Baumann P.—Pharmacokinetic-pharmacodynamic relationship of the selective serotonin reuptake inhibitors. Clin Pharmacokinet 31 (1996), pp 444-469). Because of cardiac arrhythmias and increased liver enzyme levels, electrocardiogram and laboratory values should be checked regularly.
Many types of physiologic changes that occur with aging affect the pharmacodynamics and pharmacokinetics of MAO inhibitors. Indeed, pharmacokinetic variables in the elderly are markedly different form those in younger patients. These variables including absorption, distribution, metabolism and excretion have to be taken into account to avoid or minimize certain adverse effects and drug-drug interactions. Elderly patients are generally more susceptible than younger patients to side effects, including adverse drug reactions. Hypertensive crisis may occur more frequently in elderly than in younger patients, because cardiovascular systems of the elderly are already compromised by age.
The use of sympathomimetic drugs in combination with MAO inhibitors may also elevate blood pressure. In addition, compared with placebo, phenelzine was associated with a significantly higher incidence of drowsiness, tremor, dyskinesia, diarrhea, micturition difficulties, orthostatic effects, and adverse dermatological effects. It is interesting to note that in the elderly, headache is reported with a higher frequency than in younger patients during treatment with moclobemide (Volz H. P. and Gleiter C. H.—Monoamine oxidase inhibitors. A perspective on their use in the elderly. Drugs Aging 13 (1998), pp. 341-355).
MAO inhibitors are sometimes prescribed for depression. Because of the potential risk of suicide, adverse drug reactions and toxicity due to overdose are important factors to consider when choosing an antidepressant. In addition, when MAO inhibitors are used in high dosage, adverse cardiovascular effects seem to increase considerably; and because MAO selectivity is lost with such high doses, tyramine can induce potentially dangerous hypertensive reactions. Acute overdose with MAO inhibitors causes agitation, hallucinations, hyperpyrexia, hyperreflexia and convulsions. Abnormal blood pressure is also a toxic sign, so that gastric lavage and maintenance of cardiopulmonary function may be required. Overdose of traditional non-selective and irreversible MAO inhibitors are considerably dangerous and sometimes fatal (Yamada and Richelson, 1996. Pharmacology of antidepressants in the elderly. In: David J R, Snyder L., editors. Handbook of pharmacology of aging. Boca Raton: CRC Press 1996).
In the treatment of the affections wherein sodium and calcium channels mechanism(s) play(s) a pathological role and, in particular, of pain syndromes (either of neuropathic or inflammatory type) inhibition of MAO enzymes is of no benefits. The most clinically active anti-nociceptive drugs are devoid of MAO inhibition. On the contrary, MAO inhibitory side effects may impose at least two types of negative limitations.
1) Dietary: eating food with high tyramine content may cause severe, even life threatening increase of systemic blood pressure (the so called “cheese-effect”).
2) Pharmacological: pain is often treated with a combination of drugs such as opioid derivatives and tricyclic antidepressant. With MAO inhibitors such association is dangerous as it may cause the serotoninergic syndrome (agitation, tremors, hallucination, hyperthermia and arrhythmias).
Thus, eliminating or significantly reducing MAO inhibitory activity in medicaments active as sodium and/or calcium channel modulators useful in preventing, alleviating and curing a wide range of pathologies where said mechanism(s) play(s) a pathological role, including neurological, psychiatric, cardiovascular, inflammatory, ophthalmic, urogenital and gastrointestinal diseases, is an unexpected and substantial therapeutic improvement versus compounds of similar efficacy but with the above mentioned side effects. Said improvement is particularly desirable for the medicaments active as sodium and/or calcium channel modulators useful, in particular, for the treatment of the pain syndromes.
Taken into account these findings on MAO inhibitors and, in particular, lacking any evidence on MAO-B role in pathological affections like pain, migraine, cardiovascular, inflammatory, urogenital and gastrointestinal diseases, it might be conceivable that MAO-B inhibition should not be an essential feature for compounds indicated for the above pathologies, avoiding any possible side effects during chronic and/or long-term treatments.
An advantageous solution to the above described problem would consist in providing medicaments which are “selectively active as sodium and/or calcium modulators” or a useful for the “selective treatment” of affections disorders or diseases wherein the sodium and/or calcium channel mechanism(s) play(s) a pathological role. With this expression are intended medicaments which, when administered to a patient in need thereof in amounts that are effective in the treatment of the above said affections wherein the above said mechanism(s) play(s) pathological role, do not exhibit any MAO inhibitory activity or exhibit a significantly reduced MAO inhibitory activity, thus resulting in avoidance of side effects due to accumulation of endogenous and exogenous monoamine transmitters.
It is a primary object of this invention the use of phenylethylamino derivatives for the manufacture of medicaments active as sodium and/or calcium channel modulators for the treatment of pathologies where the above said mechanism(s) play(s) a pathological role, said medicaments being substantially free from any MAO inhibitory activity or having significantly reduced MAO inhibitory activity and, therefore, having a reduced potential for unwanted side effects. Said use provides an improved selective resource for the prevention, alleviation and/or cure of the above said pathological affections.